Comfort Aids for Dementia: Weighted, Textured and Familiar Items

Understanding what comfort means in dementia

Comfort in dementia has several layers.

• Physical comfort: a seat that does not hurt, a bed that supports, the right temperature, relief of pain and a clean, dry body. A person who cannot say "my back hurts" may fidget, groan or refuse to sit.
• Sensory comfort: soft textures, warmth, gentle pressure, familiar smells and sounds, and soothing light.
• Emotional comfort: familiar objects, people and routines; a sense of being safe and not alone.
• Occupation: something to do with the hands, to ease restlessness and boredom.

Always check physical causes first. A person who is restless may be in pain, constipated, hungry, thirsty, needing the toilet, too hot or too cold, or have an infection. See dementia challenging behaviours and urinary tract infections in older adults.

Seating and cushions

Many people with dementia spend long hours sitting. A good chair and cushion help comfort and safety.

• A firm, supportive seat with arms at a height that helps standing; see choosing a chair for an older person.
• A supportive cushion to spread pressure, with skin checks; see seat cushions for older adults and gel cushions for pressure relief.
• Lumbar or side support for those who slump or lean, with care not to restrain.
• A familiar chair, in a familiar place, with a view of a window or activity.
• Contrast. A seat that contrasts with the floor so it can be seen; see dementia-friendly bathroom for similar principles.
• Avoid chairs that are too soft or deep, from which the person cannot rise, which causes frustration and falls.
• Avoid restraints, including tables and cushions used to prevent rising, which are unsafe and unethical.

Lap blankets, shawls and warmth

A soft lap blanket or shawl gives warmth and comfort, and many people enjoy stroking its texture. Choose washable, light, non-trailing fabrics that cannot catch on a wheelchair or walker. Check the temperature; a person with dementia may not say they are too hot or cold. See cold-weather warmth for older adults.

Fidget and sensory items

Hands that are restless can be occupied. Options include:

• Twiddle muffs or fidget blankets: soft muffs or lap quilts with attached buttons, zips, ribbons and textures. They occupy fingers and reduce picking at skin or clothes.
• Textured cushions with different fabrics, tassels, soft toys or a gentle rolling pillow.
• Folded cloths, towels or laundry to sort and fold, which gives purposeful occupation.
• Rummage boxes, with safe, familiar objects.
• A soft doll or toy, which some people find comforting; offer it respectfully, not as a child's toy, and follow the person's response.
• Worry beads, smooth stones and large wooden beads.
• A hand massage with unscented lotion, which many enjoy.
• Photographs and memory books.
• Music and familiar songs, which are often a powerful comfort.

Safety checks: no small parts that can be swallowed, no long cords, strings or beads that can strangle, no sharp or heavy items, no toxic materials. Check items regularly for wear. Stop if the person puts items in the mouth.

Weighted blankets and cushions: be careful

Weighted blankets and lap pads apply gentle pressure and are sold for calming. Some people with anxiety find them soothing, but there are cautions for older adults and people with dementia.

• Evidence is limited, especially in dementia.
• Risks include overheating, difficulty moving, breathing restriction, pressure on fragile skin and entrapment, particularly for people who are frail, confused, have heart or lung disease or cannot remove the blanket themselves.
• Never use on people who cannot lift or remove it, are sleeping unsupervised or have breathing problems.
• Choose a very light weight if at all, and only on advice from an occupational therapist or doctor.
• Supervise use and stop if the person is distressed.

A lighter lap blanket or lap cushion is usually safer.

Positioning in bed

Comfortable positioning improves sleep and reduces night-time restlessness.

• A supportive mattress and pillows that suit the person; see bedroom setup for night-time safety and nursing care bed for dementia.
• A pillow between the knees or a body pillow for side sleepers, if it is accepted and does not cause trips.
• Wedge pillows for reflux, if recommended; see wedge pillows.
• Avoid bed rails unless assessed, since they can cause entrapment; see bed rails guide.
• Check the skin and comfort each day.
• Keep the room calm, dark and familiar.

Reducing distress: the bigger picture

Comfort objects work best within a calm routine.

• Keep a regular daily routine for meals, medicines, activity and sleep; see dementia daily routines.
• Reduce noise and clutter, and avoid sudden changes.
• Use familiar items, such as favourite blankets, photographs and clothes.
• Keep the person active with walking, music, gardening, simple chores and conversation.
• Check the basics: toilet, food, drink, pain, temperature, glasses and hearing aids.
• Use clear, simple, calm speech; see communicating with someone who has dementia.
• Watch for evening restlessness (sundowning); see sundowning.
• Use aids that give orientation, such as clocks; see talking clocks for low vision and dementia and orientation aids for memory loss.
• Use safety devices where wandering is a risk; see wandering and dementia safety.

Respect and dignity

Use comfort aids to support the person, not to manage them. Offer items; do not force them. Treat the person as an adult with a life history. Choose items that fit their past: a former tailor may enjoy fabrics, a gardener may enjoy smooth stones and seeds, a musician may enjoy a tune. Ask the person, if possible, and watch their response. If an item causes distress, remove it. Avoid childish items unless they clearly welcome them.

Building a small comfort kit

Many families find it helpful to assemble a small box or bag of comfort items that can be offered when restlessness begins, rather than hunting for something in the moment. A basket might hold a soft lap blanket, a fidget muff, a photograph album with clear labels, a few smooth stones or large wooden beads, a hand cream the person likes, a small musical player with favourite songs and a simple task such as a bundle of cloths to fold. Keep the kit in the room where your parent spends most of the day, and refresh the items every few weeks so they stay interesting. Involve the person in choosing, and note which items work at which times of day. Share the list with every carer and visitor, so that the same response is used by everyone. Record what you try and what happens, which helps the doctor and therapist see patterns, such as restlessness before meals or after visitors. If an item seems to distress, put it away without comment and try another later.

When to ask a professional

An occupational therapist can assess seating, positioning and sensory needs and recommend aids. A doctor should assess new agitation, sleep problems or pain. A dementia nurse specialist or a day centre can advise on activities. Our care advisors can arrange assessments and trained companions. See caring for a parent with dementia at home.